Source: L. 2006: Entire article added with relocations, p. 1864, � 7, effective July 1. L. 2007: (3)(d) amended, p. 1493, � 5, effective January 1, 2008. L. 2010: (3)(a) and (3)(c)(I) amended, (HB 10-1043), ch. 92, p. 313, � 4, effective April 15. L. 2011: (3)(b) amended, (SB 11-250), ch. 219, p. 950, � 1, effective May 27; (3)(c) amended, (SB 11-008), ch. 100, p. 293, � 2, effective September 1. L. 2014: Entire section repealed, (SB 14-067), ch. 12, p. 114, � 7, effective February 27.
Editor's note: This section was similar to former � 26-4-508 as it existed prior to 2006.
25.5-5-206. Medicaid buy-in program - disabled children - disabled adults - federal authorization - rules. (1) (a) Subject to available appropriations, the state department is authorized to seek federal authorization to and to establish a medicaid buy-in program or programs for:
(I) Disabled children; or
(II) Disabled adults who do not qualify for the medicaid buy-in program established pursuant to part 14 of article 6 of this title.
(b) The medicaid buy-in program or programs established pursuant to paragraph (a) of this subsection (1) may provide for premium and cost-sharing charges on a sliding fee scale based upon a family's income.
(2) The state board shall promulgate rules consistent with any federal authorization to implement and administer the medicaid buy-in program or programs established pursuant to paragraph (a) of subsection (1) of this section.
(3) Any premiums or cost-sharing charges paid for the medicaid buy-in programs established pursuant to this section are credited to the healthcare affordability and sustainability medicaid buy-in cash fund created in section 25.5-4-402.4 (5.1).
Source: L. 2009: Entire section added, (HB 09-1293), ch. 152, p. 698, � 6, effective July 1. L. 2025: (3) added, (SB 25-228), ch. 150, p. 574, � 2, effective May 1.
25.5-5-207. Adult dental benefit - adult dental fund - creation - legislative declaration. (1) (a) The general assembly finds that:
(I) As of 2011, Colorado was one of only ten states that did not offer basic oral health services to adults under medicaid;
(II) Research has shown that untreated oral health conditions negatively affect a person's overall health and that gum disease has been linked to diabetes, heart disease, strokes, kidney disease, dementia diseases and related disabilities, and even behavioral or mental health disorders;
(III) Regular dental care and prevention are the most cost-effective methods available to prevent minor oral conditions from developing into more complex oral and physical health conditions that would eventually require emergency and palliative care;
(IV) Further, one in four adults has untreated tooth decay. Early detection and access to preventive and restorative treatments for oral health conditions can be up to ten times less expensive than treating those same conditions in an emergency setting.
(V) Research has also shown that good oral health improves medicaid beneficiaries' ability to obtain and keep employment. Employed adults lose more than one hundred and sixty-four million hours of work each year due to dental problems.
(VI) Children are more likely to receive regular dental services if their parents have access to dental services; and
(VII) Pregnant women are one of the most vulnerable adult populations that are without oral health benefits under medicaid. During pregnancy, the physical changes a woman's body undergoes can negatively affect oral health. Untreated decay and periodontal disease are associated with adverse pregnancy outcomes such as increased risk for preeclampsia, pre-term labor, and low birth weight babies.
(b) Therefore, the general assembly declares that in order to improve overall health, promote savings in medicaid programs, and prevent future health conditions caused by oral health problems, it is in the best interest of the state of Colorado to create a limited oral health benefit for adults in the medicaid program.
(2) (a) Pursuant to section 25.5-5-202 (1)(w), by April 1, 2014, the state department shall design and implement a limited dental benefit for adults using a collaborative stakeholder process to consider the components of the benefit, including but not limited to the cost, best practices, the effect on health outcomes, member experience, service delivery models, and maximum efficiencies in the administration of the benefit.
(b) The state department shall determine the most cost-effective method for providing the adult dental benefit, including but not limited to a comparison of a capitated or fee-for-service method of payment and the purchase of dental insurance.
(c) The state department shall seek any federal authorization necessary to provide the adult dental benefit.
(d) Subject to federal authorization and federal financial participation, on or after July 1, 2016, the diagnosis, development of a treatment plan, instruction to perform an interim therapeutic restoration procedure, or supervision of a dental hygienist performing an interim therapeutic restoration procedure may be provided through telehealth, including store-and-forward transfer, in accordance with section 25.5-5-321.5.
(2.5) Repealed.
(3) If the state department chooses to use an administrative service organization to manage the adult dental benefit:
(a) The contract with the administrative service organization must provide that the contracting entity is prohibited from requiring dental providers to participate in any other public or private program or to accept any other insurance products as a condition of participating as a dental provider; and
(b) The state department shall retain policy-making authority, including but not limited to policies concerning covered benefits and rate setting.
(4) (a) There is hereby created in the state treasury the adult dental fund, referred to in this section as the fund, consisting of money transferred to the fund from the unclaimed property trust fund pursuant to section 38-13-801 (3) and any money that may be appropriated to the fund by the general assembly. The money in the fund is subject to annual appropriation by the general assembly to the state department for the direct and indirect costs associated with implementing the adult dental benefit pursuant to section 25.5-5-202 (1)(w).
(b) The state treasurer may invest any unexpended moneys in the fund as provided by law. The state treasurer shall credit all interest and income derived from the investment and deposit of moneys in the fund to the fund.
(c) Any unexpended and unencumbered moneys remaining in the fund at the end of a fiscal year remain in the fund and shall not be credited or transferred to the general fund or another fund.
Source: L. 2013: Entire section added, (SB 13-242), ch. 189, p. 761, � 2, effective August 7. L. 2015: (2)(d) added, (HB 15-1309), ch. 326, p. 1334, � 7, effective August 5. L. 2017: IP(1)(a) and (1)(a)(II) amended, (SB 17-242), ch. 263, p. 1327, � 200, effective May 25. L. 2018: (1)(a)(II) amended, (HB 18-1091), ch. 74, p. 642, � 3, effective August 8. L. 2019: (4)(a) amended, (SB 19-088), ch. 110, p. 467, � 11, effective July 1, 2020. L. 2020: (2.5) added, (HB 20-1361), ch. 161, p. 756, � 1, effective June 29. L. 2021: (2.5) repealed, (SB 21-211), ch. 86, p. 358, � 1, effective May 4. L. 2024: (2)(a) amended, (SB 24-176), ch. 152, p. 646, � 46, effective August 7.
Cross references: For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.
25.5-5-208. Additional services - training - grants - screening, brief intervention, and referral. (1) On or after July 1, 2018, the state department shall grant, through a competitive grant program, one million five hundred thousand dollars to one or more organizations to operate a substance use screening, brief intervention, and referral to treatment practice. The grant program must require:
(a) Training for health-care professionals statewide, including providers who serve women of childbearing age, that is evidence-based and that may be attended either in person or online. The training must include training for reimbursement and billing codes in the Colorado Medical Assistance Act, articles 4 to 6 of this title 25.5.
(a.3) Implementation of a statewide adolescent substance use screening, brief intervention, and referral practice that includes training and technical assistance for appropriate professionals in Colorado schools, with the purpose of identifying students who would benefit from screening, brief intervention, and potential referral to resources, including treatment;
(a.5) Implementation of a statewide substance use screening, brief intervention, and referral practice that includes training and technical assistance for pediatricians and professionals in pediatric settings, with the purpose of identifying adolescent patients who would benefit from screening, brief intervention, and potential referral to resources, including treatment;
(b) Consultation and technical assistance for health-care providers, health-care organizations, and stakeholders;
(c) Outreach, communication, and education to providers and patients;
(d) Coordination with primary care, mental health care, integrated health care, and substance use prevention, treatment, and recovery efforts; and
(e) Campaigning to increase public awareness of the risks related to alcohol, marijuana, tobacco, and drug use and to reduce any stigma associated with treatment.
(2) (a) The state department contractor shall develop a patient education tool for women of childbearing age to learn about the risks of substance-exposed pregnancies, to be deployed for public use in the state.
(b) Repealed.
Source: L. 2015: Entire section added, (HB 15-1367), ch. 271, p. 1078, � 17, effective January 1, 2016. L. 2018: Entire section amended, (HB 18-1003), ch. 224, p. 1428, � 4, effective May 21. L. 2024: IP(1) amended and (1)(a.3) and (1)(a.5) added, (SB 24-047), ch. 440, p. 3081, � 9, effective June 6.
Editor's note: (1) Section 23(2) of chapter 271 (HB 15-1367), Session Laws of Colorado 2015, provides that this section takes effect only if a majority of voters approve the ballot issue referred in accordance with section 39-28.8-603 (1) at the November 2015 statewide election. If the voters approve the ballot measure, this section is effective on the date of the official declaration of the vote by the governor, or January 1, 2016, whichever is later. The ballot issue was approved by voters on November 3, 2015. The governor's proclamation was issued on December 28, 2015, establishing an effective date of January 1, 2016, for this section. The vote count for the measure was as follows:
FOR: 847,380
AGAINST: 373,734
(2) Subsection (2)(b)(II) provided for the repeal of subsection (2)(b), effective September 1, 2019. (See L. 2018, p. 1428.)
Cross references: For the legislative declaration in HB 15-1367, see section 1 of chapter 271, Session Laws of Colorado 2015.